原发性观察脂肪移植后颞部肥大的原因及吸脂术对肥大的影响。

Primary Observation of the Causes of Temporal Hypertrophy Secondary to Fat Grafting and the Effect of Liposuction on the Hypertrophy.

机构信息

Beijing Leihua Aesthetic and Plastic Clinic.

Body Sculpture and Liposuction Center of Plastic Surgery Hospital, Peking Union Medical College, China Academy of Medical Sciences, Beijing, China.

出版信息

J Craniofac Surg. 2020 Nov/Dec;31(8):2148-2155. doi: 10.1097/SCS.0000000000006628.

DOI:10.1097/SCS.0000000000006628

PMID:33136845

Abstract

OBJECTIVE

In Asia, the temporal hollowing is considered to be a sign of bad fortune and aging. Many people demand to correct the temporal hollowing with fat grafting. Subsequently, the temporal hypertrophy secondary to fat grafting become more and more. This study attempted to preliminarily explore the causes of temporal hypertrophy and observe the safety and effectiveness of liposuction in correcting temporal hypertrophy.

METHODS

A diagnostic criteria for temporal hypertrophy was established, and 55 of 78 patients who complained of temporal swelling were defined as temporal hypertrophy, and filled out a questionnaire which included patients' basic information, preoperative, intraoperative, and postoperative problems related to fat grafting, as well as their acceptance of liposuction. Analyze the results of the questionnaire to explore which factors are associated with hypertrophy. Practice liposuction on patients who are willing to try liposuction. Postoperative complications were observed to determine the safety of liposuction. The patients, doctors, and bystanders were followed up 3 months postoperative to investigate the satisfaction of the operation for analyzing the effectiveness of liposuction for temporal hypertrophy.

RESULTS

Before fat grafting, 13 (23.6%) patients without significant temporal hollowing and 42 (76.4%) patients with obvious temporal hollowing; 28 (50.9%) patients with 1 fat grafting, 20 (36.4%) with 2 fat gratings, 7 (12.7%) with 3 fat grafting. The mean time between 2 fat gratings was 4.8 months. The fat donor sites: 50 (90.9%) patients in thigh, 4 (7.3%) in abdomen, and in 1 (1.8%) in waist. The average onset time of hypertrophy in 55 patients was 13.1 months after the last fat grafting. The average onset time of temporal hypertrophy of the weight-gain group (25.7 months) was significant later than that of the weight-invariant group (7 months) (P < 0.01).No irregularities, skin necrosis, hematoma, or infection was found in all patients. One patient showed the damage to temporal branch of facial nerve on right side, which fully recovered at 1 week postoperative. 7 (22.6%) patients, 10 (32.3%) doctors, and 8 (25.8%) laypersons reported satisfactory results; 14 (45.2%) patients, 15 (48.4%) doctors, and 14 (45.2%) laypersons reported mostly satisfactory results; 10 (32.3%) patients, 6 (19.4%) doctors, and 9 (29.0%) laypersons reported dissatisfactory results.

CONCLUSIONS

To prevent temporal hypertrophy, the following points are important: to rationally choose of indication of temporal fat grafting, to wait 1 to 2 years before next fat grafting, to maintain weight stability after fat grafting, to practice conservative fat grafting, to prudently choose fat donor site. Liposuction is safe for temporal hypertrophy, but it is not easy to operate and difficult to correct all cases. Therefore, a superior treatment plan should be explored.

摘要

目的

在亚洲，颞部凹陷被认为是厄运和衰老的象征。许多人要求通过脂肪移植来矫正颞部凹陷。因此，颞部由于脂肪移植而出现的肥大越来越多。本研究试图初步探讨颞部肥大的原因，并观察吸脂术矫正颞部肥大的安全性和有效性。

方法

建立颞部肥大的诊断标准，对 78 例抱怨颞部肿胀的患者中，55 例被定义为颞部肥大，并填写一份问卷，内容包括患者的基本信息、术前、术中、术后与脂肪移植相关的问题，以及他们对吸脂术的接受程度。分析问卷结果，探讨哪些因素与肥大有关。对愿意尝试吸脂术的患者进行吸脂术。观察术后并发症以确定吸脂术的安全性。术后 3 个月对患者、医生和旁观者进行随访，以评估手术效果，分析吸脂术治疗颞部肥大的效果。

结果

脂肪移植前，13 例（23.6%）患者无明显颞部凹陷，42 例（76.4%）患者有明显颞部凹陷；28 例（50.9%）患者行 1 次脂肪移植，20 例（36.4%）行 2 次脂肪移植，7 例（12.7%）行 3 次脂肪移植。2 次脂肪移植的平均间隔时间为 4.8 个月。脂肪供区：50 例（90.9%）为大腿，4 例（7.3%）为腹部，1 例（1.8%）为腰部。55 例患者中，45 例（81.8%）为单侧，10 例（18.2%）为双侧。55 例患者中，颞部肥大的平均发病时间为最后一次脂肪移植后 13.1 个月。体重增加组（25.7 个月）的颞部肥大平均发病时间明显晚于体重不变组（7 个月）（P < 0.01）。所有患者均未出现不规则、皮肤坏死、血肿或感染。1 例患者右侧面神经颞支受损，术后 1 周完全恢复。7 例（22.6%）患者、10 例（32.3%）医生和 8 例（25.8%）旁观者报告结果满意；14 例（45.2%）患者、15 例（48.4%）医生和 14 例（45.2%）旁观者报告结果大部分满意；10 例（32.3%）患者、6 例（19.4%）医生和 9 例（29.0%）旁观者报告结果不满意。